A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were.
The civil suit alleges that Aledade’s billing apps and other software and guidance provided to doctors improperly boosted revenues by adding overstated medical diagnoses to patients’ electronic medical records.
“Aledade did whatever it took to make patients appear sicker than they were,” according to the suit.
For example, the suit alleges that Aledade “conflated” anxiety into depression, which could boost payments by $3,300 a year per patient. And Aledade decided that patients over age 65 who said they had more than one drink per day had substance use issues, which could bring in $3,680 extra per patient, the suit says.
The whistleblower case was filed by Khushwinder Singh, MD, in federal court in Seattle in 2021 but remained under seal until January of this year. Singh, a “senior medical director of risk and wellness product” at Aledade from January […]
As the article states: “Aledade is one of hundreds of groups known as accountable care organizations.” and “Aledade has grown rapidly behind hundreds of millions of dollars in venture capital financing and was valued at $3.5 billion in 2023.” Accountability is something sorely lacking in the power structure of the United states. It will be interesting to see how “accountable” this organization, and more importantly its leadership, will be. Or will this be an exercise in learning who should have been the recipient of campaign cash so that a “loophole” in the regulations can be “found”. I understand that the religion of “Capitalism” as practiced in the United States is sacred; however, the American people must learn that the pursuit of profit, and the provision of appropriate healthcare are mutually exclusive.
I agree with you, Mr. Eddie.